Causes of digestive symptoms in patients with COVID-19

Abstract

This literature review discusses the problem of the causes of digestive symptoms in COVID-19 patients, examining papers in which SARS-CoV-2 gastrointestinal infection was the underlying cause of symptoms and papers in which the occurrence of such symptoms was associated with exacerbation of pre-existing, including previously undiagnosed GI diseases. Objective: to identify the most likely underlying cause of digestive symptoms in COVID-19 patients. Materials and Methods. We searched 59 literature sources from eLibrary, PubMed, Scopus, and Google scholar databases. All papers were published in the last 4 years. Results. The resulting digestive symptoms in coronavirus lesions are caused by direct disruption of the intestinal barrier; also, these symptoms may be a manifestation of exacerbation or debut of chronic digestive diseases on the background of COVID-19, and exacerbate the course of infection; or a result of COVID-19 therapy. A differential diagnosis of COVID-19 with inflammatory bowel diseases, chronic liver diseases, chronic and acute biliary pancreatitis is required in patients with diarrhea, abdominal pain, elevated blood liver and pancreatic enzymes. The correlation of gastroenterological symptoms with the direct COVID-19 lesion can be established by comparing the clinical picture with the detection of RNA virus in stool, histologic specimens, but sometimes there may be no unambiguous answer. Specific changes on computed tomography with angiography of the abdominal cavity organs (peri-intestinal fatty tissue strands against the background of intestinal wall thickening) are described only in the initial stage of COVID-19, at later stages the changes are nonspecific. Data from endoscopic studies in patients with COVID-19 are limited to single clinical cases or case series describing nonspecific findings and suggesting that the virus directly damages GI mucosal surfaces. This calls into question the results of the studies that have been conducted, most of which were retrospective and did not evaluate the baseline presence of gastrointestinal symptoms prior to COVID-19. Due to the peculiarities of the virus interaction with body cells and the diversity of clinical manifestations of the disease, a combined approach in the diagnosis of GI diseases in COVID-19 is necessary.